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CASES. 


BY 
WILLIAM P. SPRATLING, M. D., 


SONYEA, N. Y. 


Reprinted from the 
Hew York Medical Journal 


and Philadelphia Medical Journal 


CONSOLIDATED 


for April 9 and 16, 1904 


A A SS Pe 
RASS a 


Reprinted from the New York Medical Journal and Phila- 
delphia Medical Journal, Consolidated, for 
April 9 and 16, 1904. 


GUIDES -TO "THE PROGNOSIS IN . EPI- 
BERSYs) WITH? REMARKS ON: THE 
Pin mpl lt yO Hoth. DISKASEH: 
DNC DING OGREPORTS: «OF 
MHI RY POURS CASES? 


By WILLIAM P. SPRATLING, M. D., 
SONYEA, N. Y., 


MEDICAL SUPERINTENDENT OF THE CRAIG COLONY FOR EPI- 
LEPTICS ; SECRETARY OF THE NATIONAL ASSOCIATION FOR 
THE STUDY OF EPILEPSY AND THE CARE AND TREATMENT 
OF EPILEPTICS; MEMBER OF THE AMERICAN MEDICAL 
ASSOCIATION, NEW YORK ACADEMY OF MEDICINE, NEW 
YORK COUNTY MEDICAL SOCIETY, AMERICAN MEDICO- 
PSYCHOLOGICAL ASSOCIATION, ROCHESTER PATHOLOGICAL 
SOCIETY, BUFFALO ACADEMY OF MEDICINE, ETC. 


After an experience of fourteen years’ in the daily 
care and treatment of 1,800 cases of epilepsy in per- 
sons of all ages, types, conditions, and degrees of 
duration of the disease, I feel justified in reaching 
these conclusions regarding its prognosis and cure: 

First. Epilepsy is curable in from 5 per cent. to 
Io per cent. of all cases. 

Second. It requires, as a rule, a long continued 
course of treatment—never less than two to three 


* Read before the New York Academy of Medicine on Jan- 
uary 7, 1904. 


1Nine years of this experience was acquired by the writer 
as chief physician at the Craig Colony for Epileptics, at Sonyea, 


COPYRIGHT, 1904, BY A. R. ELLIOTT PUBLISHING Co. 


Spratling: Prognosis in Epilepsy. 


years—carefully mapped out and executed to the 
letter, not only along one, but along many lines, to 
effect a cure. 

Third. The failure to secure better results, gen- 
erally, in the treatment of this disease must fre- 
quently be laid to the failure to treat the individual 
and his disease as a unit, and to treat them both 
along the very broad, comprehensive, and unyield- 
ing lines they both require. 

Fourth. The drug treatment of epilepsy alone, 

\ while invaluable in many cases and of some use in 
every case, often fails completely to meet the most 
important requirements. 

Fifth. Guides to the prognosis in epilepsy are al- 
ways uncertain and unsatisfactory until treatment 
has been in operation from six to nine months, and 
in some cases a year or longer. 

With these conclusions in view, and in order that 
I might present the subject it is my pleasure to dis- 
cuss before you this evening in as lucid a manner 
as possible, I will confine my remarks largely to the 
interesting and important facts grouped about a 
series of thirty-four cases of this widely prevalent 
and very obstinate disease that have been cured at 
the Craig Colony up to this time. 

The subject of epilepsy is far too vast to bring 
into this brief discussion anything bearing on its 
treatment. We must confine ourselves just now 


N. Y.; five years as first assistant physician in the New Jersey 
State Hospital, at Morris Plains, an institution in which a large 
number of epileptics were cared for at that time (1887 to 
1892); while it was also the writer’s privilege to spend some 
time as a resident of the German Colony for Epilepties, at Biele- 
feld, for the purpose of studying the methods in vogue in that 
very “uccesaful institution, and their results. 


2 


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Spratling: Prognosis in Epilepsy. 


solely to results, and to the guides that may help to 
point them out in advance; and if I here express it 
as my unqualified belief that the methods in use at 
the Craig Colony are the best, or that we are striv- 
ing to make them the best, yet devised for the treat- 
ment of the epileptic and his disease; and that our 
system of records prior to, and after, the patient 
comes under our care, is as complete as we have 
been able to this time make it, I do so, not with any 
degree of pride in such facts, but expressly to show 
that the gratifying results I am able to report to- 
night were neither carelessly attained nor hap- 
hazardly compiled. 

We persistently follow cases for years; we in- 
stantly record every seizure that occurs on the col- 
ony, writing down its type, its duration, and its 
severity; we use manifold drugs, foods of desig- 
nated kinds; forms of occupation suitable for all 
who are capable of it; demanding rest in some cases 
and in others healthy fatigue; and we measure the 
degree of success we attain by our ability to apply 
well rounded and complete forms of treatment to 
individuals whose visible malady is only a symptom 
complex, and who often require the most complex 
forms of treatment, covering several years’ time. 

Personally, I am so sure that epilepsy is curable 
that I am forced to feel that those (if there are any) 
who doubt or deny this fact, do so without having 
had opportunity for witnessing the results that fol- 
low lines of treatment, broadly conceived, faithfully / 
executed, and kept up as long as the nature of the 
malady requires. 

In the condenséd report of the thirty!four cases 


3 


Spratling: Prognosis in Epilepsy. 


that follow will be found in some detail the essential 
facts of interest that are dealt with in summarized 
form further on. 


CasE 4 (Colony No.).—Male; age at onset 
of epilepsy, ten years; type of epilepsy, petit mal, 
occasionally grand mal; duration of the disease on 
admission, sixteen years; attacks occurred at rate 
of twelve to fourteen a day prior to patient’s ad- 
mission to the colony; total approximate number of 
attacks before admission, 50,000 to 60,000; mental 
condition, impaired, improvement noted in it shortly 
after patient came under treatment; aura, “ con- 
fused and dizzy feeling,” some moments before the 
fit appeared. Duration of treatment at the colony, 
two years and three months. Length of time pa- 
tient had remained free from epilepsy on January 1, 
1904, seven years and a half. 

This patient had previously been mentioned in 
colony reports as having had approximately 25,000 
seizures before his admission to the colony. A re- 
cent and more careful inquiry into his previous his- 
tory indicates that he had a much larger number 
than that. He was admitted to the Utica State Hos- 
pital on October 2, 1884, and had, according to the 
records, during that month, an average of thirteen 
fits daily, and during the November following he 
had twelve fits daily. He was discharged un- 
improved on December 7th, the same year. He was 
next admitted to the St. Lawrence State Hospital 
on July 7, 1894. A note in the hospital records on 
July 10, 1894, is as follows: “ Patient has had sev- 
eral convulsions each day since admission; ’”’ August 
roth, “ Continues to have convulsions frequently ; ” 
August 18th, “ Has had convulsions in rapid suc- 
cession, stupid and weak.” Discharged unimproved, 
October 18, 1894.? 


7] am indebted to Dr. Palmer and Dr. Hutchings, superin- 
tendents at Utica and Ogdensburg, for notes in this case. 


4 


Spratling: Prognosis in Epilepsy. 


I present this patient’s record of seizures while he 
was at the colony. He had 222 in all, all save one 
occurring during the first three months of his resi- 
' dence there; an isolated attack, due to a prevent- 
able indiscretion, occurring after he had been at the 
colony four months. 

Between the 12th of June, 1896 (the date on 
which he left Sonyea), and January 1, 1904, he had 
no attacks. Four years after leaving Sonyea, he 
wrote me: “ No manifestation of the old disease has 
ever recurred since my leaving Sonyea. Am still 
employed at the same office, and have not missed a 
day since last writing you.” Again, at the end of: 
five years, he wrote: “I have practically forgotten 
that I was ever obliged to become a patient at the 
colony, for my health remains perfect in every way, 
enabling me to attend to my daily duties in the office 
regularly, without knowing what sickness means.” 
A month ago—seven years and a half after his last 
attack—he wrote me: “I am very well. Should 
much enjoy looking over the ‘ old stamping ground ’ 
at Sonyea, where I received such a blessing.” 

This man now having gone more than seven years 
without an attack, I regard him as cured of the epi- 
lepsy he suffered from for sixteen years before he 
entered the colony. Should he fail, however, to live 
at home as he was taught and made to live at 
Sonyea, he may possibly suffer a second attack. I 
see no reason why repeated attacks of epilepsy may 
not follow the reapplication of causes, any more 
than why a person may not have two or more at- 
tacks of any other disease after exposure to the in- 
fluences that produce them. 


3 


Spratling: Prognosis in Epilepsy. 


CasE 17 (Colony No.).—Female; age at on- 
set of epilepsy, fifteen years; type of epilepsy, grand 
mal; duration on admission, two years; attacks oc- 
curred at the rate of one every two weeks prior to | 
admission ; total approximate numbers of attacks be- 
fore entering the colony, 12; number after entering, 
2; duration of treatment, two years and a half; men- 
tal condition, impaired; aura, none. Length of time 
patient was free from epilepsy to January I, 1904, 
three years and a half. 


CasE 50 (Colony No.).—Female; age at on- 
set of epilepsy, six years; type of epilepsy, grand 
mal and petit mal; duration on admission, twenty- 
seven years; frequency of attacks before admission, 
daily; approximate total number of attacks before 
entering the colony, 9,758; number after entering 
the colony, none; mental condition, fair; aura, none. 
Duration of treatment, two years and a half; length 
of time free from attacks to January I, 1904, five 
years and two months. 


CasE go (Colony No.).—Male; age at on- 
set of epilepsy, fourteen years; type, grand mal; 
duration on admission, two years; frequency of at- 
tacks before entering the colony—at first, six 
months apart; later, and at time of admission,,sev- 
eral a month; total approximate number of attacks 
before entering the colony, 50; number after enter- 
ing the colony, 30; mental condition, good. Patient 
a reformatory subject, vicious, criminally inclined ; 
aura, epigastric. Duration of treatment, two years 
and four months; length of time free from attacks 
to January 1, 1904, five years and three months. 


Case 93 (Colony No.).—Male; age at onset 
of epilepsy, fifty-seven years; type, grand mal; du- 
ration on admission, one year; frequency of attacks 
before entering the colony, 1 a month; approximate 
total number before entering the colony, 12; num- | 
ber after entering the colony, none; mental condi- 


6 


Spratling: Prognosis in Epilepsy. 


tion, somewhat impaired; aura, none. Duration of 
treatment, two years and four months; length of 
time free from epilepsy to January I, 1904, five years 
and two months. 


CasE 138 (Colony No.).—Male; age at onset 
of epilepsy, sixteen years; type, grand mal; dura- 
tion on admission, twenty-five years; frequency of 
attacks before entering the colony, once a week; 
approximate total number before entering the col- 
ony, 1,300; number after entering the colony, none; 
mental condition, not impaired by epilepsy—intelli- 
gence naturally of low order; aura, “ flashes of 
light; then darkness.” Duration of treatment, .a 
year and a half; length of time free from epilepsy to 
January I, 1904, five years and nine months. 


CasE 157 (Colony No.).—Female; age at on- 
set of epilepsy, nineteen years; type, grand mal; 
duration on admission, one year; frequency of at- 
tacks before entering the colony, only four, all told— 
the last, five weeks before admission; number after 
entering the colony, 1; mental condition, good—a 
little depressed at times; aura, none. Duration of 
treatment, one year and nine months; length of 
time free from attacks to January 1, 1904, five years 
and two months. 


CasE 195 (Colony No.).—Male; age at onset 
of epilepsy, eleven years; type, grand mal; duration 
on admission, four years; frequency of attacks be- 
fore entering the colony, 2 a week; approximate 
total number before entering the colony, 200; number 
after entering the colony, 109; mental condition, fair 
—nho impairment due to epilepsy; aura, epigastric. 
Duration of treatment, two years and four months , 
length of time free from epilepsy to January 1, 1904, 
four years and a half. 


Case, 281 (Colony No.).—Male; age at onset 
of epilepsy, thirty years; type, grand mal; duration 


i. 


Spratling: Prognosis in Epilepsy. 


on admission, ten years; frequency of attacks before 
admission, 2 a month; approximate total number 
before entering the colony, 250; number after enter- 
ing the colony, 11; mental condition, good; aura, 
none. Duration of treatment, five years; length of 
time free from attacks to January 1,1904,four years 
and a half. 


CASE 293 (Colony No.).—Male; age at on- 
set, eight years; type, grand mal and petit mal; 
duration on admission, thirty-six years; frequency 
of attacks before entering the colony, 12 a week; 
approximate total number of attacks before admis- 
sion, 36,000; number after entering the colony, 14; 
mental condition, good; aura, none. Length of time 
free from attacks to January I, 1904, three years 
and seven months. 


CasE 325 (Colony No.).—Female; age at 
onset of epilepsy, seven years; type, grand mal; 
duration on admission, seven years ; frequency of at- 
tacks before entering the colony, once a month dur- 
ing year preceding admission, with the exception 
of the last two months; approximate total number 
of attacks, 11; number of attacks after entering the 
colony, none; mental condition, good; aura, none. 
Duration of treatment, two years; length of time - 
free from attacks on January I, 1904, five years and 
nine months. | 


CasE 357 (Colony No.).—Male; age at on- 
set of epilepsy, five years; type, grand mal; dura- 
tion of epilepsy, twenty years; frequency of attacks 
before entering the colony, every month; approxi- 
mate total number in that time, 240; number after 
admission, none; mental condition, good except for 
some bromide stupor; aura, epigastric. Duration 
of treatment, one year; length of time free from at- 
tacks to January 1, 1904, five years and a half. 


CasE 364 (Colony No.).—Female; age at 
onset of epilepsy, thirteen years; type, grand mal 


8 


Spratling: Prognosis in Epilepsy. 


and petit mal; duration of epilepsy on admission, 
two years; frequency of attacks before entering the 
colony—at first, 2 to 3 in twenty-four hours; at time 
of admission, 15 to 23 in twenty-four hours; ap- 
proximate total number of attacks in that time, 
4,300; number after entering the colony, 2,830; 
mental condition, some temporary impairment ; aura, 
“ queer feeling in the arms.” Duration of treatment, 
three years and a half; length of time free from at- 
tacks to January 1, 1904, four years and two months. 


CasE 370 (Colony No.).—Female; age at 
onset, twenty-one years; type, grand mal; duration 
on admission, one year; frequency of attacks before 
entering the colony, three only during ten months 
prior to admission; number after entering the col- 
ony, 4; mental condition, good; aura, none. Dura- 
tion of treatment, five years and six months; length 
of time free from attacks to January 1, 1904, two 
years and seven months. 


CasE 382 (Colony No.).—Male; age at onset 
of epilepsy, eight years; type, grand mal and petit 
mal; duration on admission, twelve years; frequency 
of attacks before entering the colony, I a week; ap- 
proximate total number in that time, 600; number 
after admission, none; mental condition, congenital- 
ly weak—no impairment due to epilepsy ; aura, none. 
Duration of treatment, two years and two months; 
length of time free from epilepsy to January 1, 1904, 
five years and four months. 


CasE 446 (Colony No.).—Male; age at onset 
of epilepsy, seven years; type, grand mal; duration 
on admission, seven years; frequency of attacks dur- 
ing that time—at first, weekly; then once a month; 
approximate total number of attacks before entering 
the colony, 375; number after entering the colony, 
none ; mental condition, fair; aura, headache. Dura- 
tion of treatment, three years and a half; length of 


~) 


Spratling: Prognosis in Lpilepsy. 


time free from epilepsy to January 1, 1904, five 
years. 


Case 452 (Colony No.).—Male; age at onset 
of epilepsy, eight years; type, grand mal; duration 
on admission, fourteen years; frequency of attacks 
before entering the colony—at first, one a day; then 
several in one night; approximate total number in 
that time, 5,200; number after entering the colony, 
204; mental condition, insane, pronounced delusions 
of persecution that lasted for two months after ad- 
mission; aura, none. Duration of treatment, three 
years; length of time free from attacks to January 
I, 1904, five months. He left the colony in January, 
1902, and was readmitted four months later. From 
April 30 to August 8, 1903, he had 644 attacks. 
Has now gone five months without any. 


This case typically illustrates the type of epileptic 
who must live in a certain manner to escape the 
accentuations of the disease. He may always bear a 
strong liability to the disease, but he need not have 
epileptic convulsions, so long as he lives in a way 
to avoid them. Freedom from epilepsy by right 
living should be his perpetual aim. 


Case 480 (Colony No.).—Male; age at onset 
of epilepsy, nine years; type, grand mal; duration 
on admission, ten years; frequency of attacks before 
entering the colony, I every six weeks, about; ap- 
proximate total number before admission, 180; num- 
ber after admission, 2; mental condition, enfeebled ; 
aura, dizziness, numbness in left (paralyzed) side. 
Duration of treatment, four years and four months; 
length of time free from attacks to January I, 1904, 
two years and nine months. s 


Case 489 (Colony No.).—Female; age at on- 
set of epilepsy, eight years; type, grand mal; dura- 
tion of epilepsy on admission, seven years; fre- 


Io 


Spratling: Prognosis in Epilepsy. 


quency of attacks before entering the colony—at 
first, once a year; during the past three years, 3 to 5 
a year; approximate total number of attacks before 
entering the colony, 20; number after admission, 4; 
mental condition, unimpaired; aura, none. Duration 
of treatment, three years and eight months; length 
of time free from attacks on January I, 1904, three 
years and four months. 


CasE 517 (Colony No.).—Female; age at 
onset of epilepsy, nineteen years; type, hystero- 
epilepsy, with occasional grand mal attacks; dura- 
tion of epilepsy on admission, one year; frequency 
of attacks before entering the colony—at first daily ; 
then every two to three days; approximate total 
number before entering the colony, 200; number 
after entering the colony, 37; mental condition, un- 
impaired—patient very emotional; aura, none. Du- 
ration of treatment, three years; length of time free 
from attacks on January I, 1904, three years and five 
months. 


CasE 528 (Colony No.).—Male; age at on- 
set of epilepsy, three years; type, grand mal and 
petit mal; duration of epilepsy on admission, six 
years and a half; frequency of attacks before enter- 
ing the colony, “ several daily;”’ approximate total 
number before entering the colony, 2,000; number 
after entering the colony, 140; mental condition 
when admitted, somewhat enfeebled; nature of aura, 
epigastric nausea. Duration of treatment, four years 
and one month; length of time free from attacks 
on January I, 1904, two years and six months. 


CasE 534 (Colony No.).—Female; age at 
onset of epilepsy, twenty-one years; type, grand 
mal; duration of epilepsy on admission, eleven 
years; frequency of attacks before entering the col- 
ony—I attack in every three to five weeks ; approxi- 
mate total number of attacks before entering the 


ime 


Spratling: Prognosis in Epilepsy. 


colony, 120; number after entering the colony, 23; 
mental condition, memory impaired—forgetful ; 
aura, patient exceedingly irritable for some time be- 
fore attacks. Duration of treatment, four years and 
eleven months; length of time free from attacks on 
January 1, 1904, two years and nine months. 


CasE 582 (Colony No.).—Male; age at onset 
of epilepsy, eight years; type, grand mal; duration 
of epilepsy on admission, two years; frequency of 
attacks before entering the colony, daily; approxi- 
mate total number of attacks before entering the 
colony, 730; number after entering the colony, 644; 
mental condition when admitted, imbecile; aura, 
none. Duration of treatment, four years; length of 
time free from attacks on January 1, 1904, tw9 
years. 


CasE 599 (Colony No.).—Male; age at onset 
of epilepsy, eighteen years; type, petit mal; duration 
of epilepsy on admission, two years; frequency of 
attacks before entering the colony, 4 to 5 daily; 
approximate total number of attacks before entering 
the colony, 3,500; number after entering the colony, 
884; mental condition when admitted, good; aura, 
“tickling sensation confined to the neck.” Duration 
of treatment, two years and a half; length of time 
free from attacks on January 1, 1904, three years 
and two months. 


Case 631 (Colony No.).—Male;. age at onset 
of epilepsy, two years and a half; duration of epi- 
lepsy on admission, thirteen years and a half; fre- 
quency of attacks before entering the colony—first 
two attacks, one year apart; between the ages of two 
years and a half and twelve years had an attack on 
an average of every six weeks; between the ages of 
twelve to fifteen years had 3 attacks; approximate 
total number of attacks before entering the colony, 
112; number after entering the colony, 11; mental 
condition when admitted, impaired; aura, numbness 


12 


Spratling: Prognosis in Epilepsy. 


in paralyzed side (hemiplegic). Duration of treat- 
ment, three years and nine months; length of time 
free from attacks on January I, 1904, three years 
and one month. 


CasE 662 (Colony No.).—Male; age at onset 
of epilepsy, five days; type, grand mal; duration of 
epilepsy on admission, twenty years; frequency of 
attacks before entering the colony—at first, “ very 
frequent; ” at the time of admission they were occur- 
ring at the rate of I every five or six months; ap- 
proximate total number of attacks before entering 
the colony, impossible to ascertain with any degree 
of accuracy; number after entering the colony, 
none; mental condition, feeble minded; aura, none. 
Duration of treatment, three years and nine months ; 
length of time free from attacks on January I, 1904, 
three years and nine months. 


CasE 817 (Colony No.).—Male; age at onset 
of epilepsy, fifteen years; type grand mal and petit 
mal; duration on admission, five years; frequency 
of attacks before entering the colony, every four to 
five months; approximate total number of attacks 
before entering the colony, 15; number after ad- 
mission, I; mental condition when admitted, good; 
aura, dizziness. Duration of treatment, one year 
and eight months; length of time free from attacks 
on January I, 1904, three years and six months. 


Case 819 (Colony No.).—Male; age at onset 
of epilepsy, four years; type, grand mal; duration 
of epilepsy on admission, eight years; frequency of 
attacks before entering the colony—indefinite; had 
several during infancy; approximate total number 
before entering the colony, indefinite; number after 
admission, 4; mental condition, imbecile; aura, none. 
Duration of treatment, three years and six months; 
length of time free from attacks on January 1, 1904, 
three years. 


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Spratling: Prognosis in Epilepsy. 


Case 847 (Colony No.).—Male; age at onset 
of epilepsy, five years; type, petit mal; duration of 
epilepsy on admission, twenty years; frequency of 
attacks before entering the colony, I a month; ap- 
proximate total number of attacks before entering 
the colony, 240; number after admission, none; 
mental condition on admission, feeble minded; aura, 
none. Duration of treatment, three years and three 
months ; length of time free from attacks on January 
I, 1904, three years and three months. 


CasE go1 (Colony No.).—Male; age at onset 
of epilepsy, two years; type, grand mal and petit 
mal; duration on admission, six years; frequency of 
attacks before entering the colony—at first, 3 to4a 
month; later, I every three or four days; approxi- 
mate total number of attacks before admission, 200; 
number after admission, 7; mental condition, good; 
aura, epigastric. Duration of treatment, two years 
and eleven months; length of time free from attacks 
on January I, 1904, two years and one month. 


CasE 957 (Colony No.).—Male; age at onset 
of epilepsy, thirty-five years; type, petit mal; dura- 
tion of epilepsy on admission, six years; frequency 
of attacks before entering the colony, I a month; 
approximate total number of attacks before admis- 
sion, 72: number after admission, none; mental con- 
dition, good; aura, “a cold feeling.” Duration of 
treatment, two years and nine months; length of 
time free from attacks on January I, 1904, two years 
and nine months. 


CasE 977 (Colony No.).—Male; age at onset 
of epilepsy, nine years; type, grand mal; duration of 
epilepsy on admission, ten years; frequency of at- 
tacks before entering the colony—at time of admis- 
sion, I every three months; at first, oftener than 
that; approximate total number of attacks before 
admission, 40; number after admission, I; mental 
condition, feeble minded; aura, vertigo. Duration 


15 


Spratling: Prognosis in Epilepsy. 


of treatment, two years and nine months; length of 
time free from attacks on January I, 1904, four 
years and four months. 

CASE 1,156 (Colony No.).—Male; age at onset 
of epilepsy, five years and a half; type, grand 
mal; duration of epilepsy on admission, three years 
and a half; frequency of attacks before entering the 
colony—first 2 attacks thirteen months apart; 3 
four months later, then none for fifteen months; 
had 2 attacks in August, 1901; approximate total 
number of attacks before entering the colony, 5; 
number of attacks after entering the colony, I ; men- 
tal condition, good; aura, none. Duration of treat- 
ment, one year and ten months; length of time free 
from attacks on January I, 1904, one year and ten 
months. 

CASE 1,250 (Colony No.).—Male; age at onset 
of epilepsy, nine years; type, grand mal; dura- 
tion of epilepsy on admission, sixteen years; fre- 
quency of attacks before entering the colony—at 
first they were six weeks apart; at time of admission 
they were eight weeks apart; approximate total 
number of attacks before entering the colony, 112; 
number after entering the colony, 1; mental condi- 
tion, good; aura, vertigo. Duration of treatment, 
one year and six months; length of time free from 
attacks on January I, 1904, fourteen months. 


The first point of interest in connection with these 
cases is the age at which the disease first developed. 

In 20, or 59 per cent., it developed before the tenth 
year; in 9, or 2614 per cent., between the tenth and 
twentieth vears; and in 4, or 12 per cent., between 
the twentieth and fortieth year (the majority of 
these occurring before the thirtieth year), while it 
commenced in 1 only after the fortieth year. 

But, before ascribing any prognostic value to 
youth, we must remember that epilepsy is essentially 

16 


Spratling: Prognosis in Epilepsy. 


an early life disease; that fully eighty per cent. or 
more of all cases occur before the twentieth year, 
and that recoveries are, therefore, simply more fre- 
quent at the age the disease itself most frequently 
arises. 

At the same time there is another factor in the 
successful treatment of young epileptics, that was 
first observed by Gowers, and in which I have come 
fully to agree, and that is that the best results can 
often be secured in cases in which heredity is sup- 
posed to have been most active as a cause. A knowl- 
edge of the handicap of heredity seems not infre- 
quently to make the treatment of the young epileptic 
doubly cautious and exacting, constantly keeping 
- him free from influences likely to stir his epileptic 
‘predisposition to action. 

The second point of interest is found in the type 
of epilepsy these patients suffered from. Twenty- 
three of them had grand mal attacks alone; 7 had 
grand mal and petit mal attacks combined; 3 petit 
mal only; while 1 had hysteroepileptic convulsions 
of great violence, with occasional attacks of grand 
mal, uncontaminated by hysteria. 

It is noted that no case of psychic epilepsy appears 
among them. The best reason for this, perhaps, is 
found in the comparative rarity of this form of dis- 
ease. In 1,325 cases studied at Sonyea, only 4 were 
classed as psychic. At the same time I do not 
regard even this form of epilepsy incurable in some 
‘cases. Its cure is least to be expected in those who 
show early or marked intellectual impairment or 
who have a very striking intellectual aura. 


17 


an 
/ a | 


Spratling: Prognosis in Epilepsy. 


We also note the absence of cases of Jacksonian 
epilepsy, a form of the disease generally regarded 
as quite curable. A probable reason for this is that 
we get so few patients at Sonyea, whose disease 1s 
not chronic (less than 1% per cent. of them have 
had the disease less than a year). In the same 1,325 
cases referred to above there were 9 Jacksonian epi- 
leptics only, and the majority of these were due to 
organic causes, such as cerebral hemorrhage, of too 
long standing to admit the possibility of a cure. Fits 
that are localized in the beginning, and called Jack- 
sonian, may later on pass into a more general form 
of the disease, losing their greater possibility of cure 
by reason of such transformation. Of all the forms 
of epilepsy, the Jacksonian type demands the earliest 
treatment. 

The next point of interest, and one of great value, 
is the duration of the treatment. 

It is the epileptic’s misfortune that the length of 
time he is kept under treatment is often far too short 
to be of effective and lasting value. 

The shortest period of treatment in any of the 
34 cases under discussion was twelve months, only 
one being as brief as that, the short treatment in 
that being unavoidable. . 

The longest period was sixty-six months—five 
years and a half—while the average for the whole 
number was thirty-five months and a quarter a 
stantially three years. 

Persistency in treatment is always to be com- 
mended. The patient and his friends should be 
actively impressed with its necessity. Good results 
are sometimes delayed for several months, or even 


18 


Spratling: Prognosis in Epilepsy. 


years, to finally appear in an abrupt but very gratify - 
ing’ manner. 

This is shown in case 582, in which the patient 
had 42 to 8g seizures each month during the first 
year, aggregating 633 in that time, and in spite of 
the most persistent treatment, quite suddenly the 
attacks underwent a marked decrease early in the 
second year, during which nine only occurred ; while 
during the third and last year of the disease there 
was but a single fit. 

The duration of the disease when the patient 
comes under treatment, is a point of some prognos- 
tic value. 

In the cases under discussion, 13 of them had suf- 
fered from epilepsy from one to five years; 10 from 
five to ten years; 7 from ten to twenty years; while 
4 had had it twenty years or more. 

These figures appear to indicate that while the 
degree of chronicity should have some weight in 
arriving at a prognosis, it cannot be held that even 
marked chronicity should be regarded as a cause of 
failure to cure. While it is generally true that the 
more frequent the attacks, and the greater their 
number in the aggregate, the less favorable the 
prognosis, because of the generally disastrous effects 
the attacks are likely to produce, there are notable 
exceptions to it. Take Case 4, for instance, in which 
there were from 50,000 to 60,000 seizures during 
the sixteen years of this man’s illness, yet he finally 
made a complete recovery. | 

Another patient (No. 50) had 9,758 seizures dur- 
ing twenty-seven years; a third (No. 364) had 4,300 
during the two years preceding his admission to the 


19 


Spratling: Prognosis in Epilepsy. 


colony, and 2,830 after admission. Both of these 
recovered fully later on. 

On the other hand, infrequent attacks do not 
necessarily argue a favorable termination, and in my 
experience many such cases require a longer treat- 
ment than do the severer ones. 

Case 489 had only 20 attacks during seven years. 
before coming to Sonyea, and 4 after admission; a 
second case (No. 1,156) had only 5 attacks in three ~ 
years and a half before, and 1 after admission. 

‘The patients who had 50,000 to 60,000, and 9,758: 
seizures respectively, were cured in two years and a 
half, while those who had 20 and 5 attacks respect- 
ively had to remain under treatment three years and’ 
a half. 

I have sometimes thought that there must be some 
relationship between the facile expression of attacks,. 
and the ease with which they yield to proper treat- 
ment, on the one hand, and the attacks that appear 
only under great provocation and at long intervals,. 
and the stubbornness with which they resist the most: 
persistent efforts to dislodge them. 

There is also this about some occasional attacks. 
to which I have previously called attention: they 
seem to appear in selected cases, at long intervals, as-. 
expressing the acme of some morbid state from: 
which the patient must find relief or become insane. 
Time and again I have seen this occur, in some cases. 
over and over again, during the past seven to eight 
years. It must be either an occasional epileptic con- 
_ vulsion, or insanity of an active and disorganizing” 

kind. And insanity usually comes in the end. 

It is, therefore, never safe, in my opinion, to tell% 


20 


Spratling: Prognosis in Epilepsy. 


a patient with positiveness during the first months 
or year of his treatment, that his chances of recovery 
are good because his attacks are so infrequent. 

Aura in Prognosis.—Eighteen, or a fraction over 
50 per cent. of the cases under review, were subject 
to an aura of some kind, and it is worthy of note 
that all save three were sensory in type. Five of 
the 18 had an epigastric aura, the rest being disturb- 
ances in sensation in some other part of the body. 

It is impossible, at this time, to ascribe to the aura 
anything of significant value in the prognosis of 
epilepsy. 

The Influence of Sex.—Twenty-five of the 34 
cases were in males, and 9 in females, but we must 
not hastily conclude that the prognosis is therefore 
better in males than in females. 

It is well established that more males than females 
have the disease, in the ratio of 20 of the former to 
16 of the latter in every hundred. I have established 
this fact through a study of 68,040 cases in this 
country and in Europe, running back to 1854. Of 
this number 36,865 were males, 31,175 females. 

A local. cause of the disproportion in the sex of 
those cured at Sonyea has been the constant treat- 
ment of 150 more males than females, on account 
of greater accommodations for the former. 

Turner, Reynolds, Gowers, and others agree that 
while the disease seems capable of arrest oftener in 
males than in females, the proportion of confirmed 
cases, at the same time, is greater among males. 

Notwithstanding all this, I am quite fully pre- 
pared to believe, if not to assert, that after the twen- 
tieth year or thereabouts, when the disease begins 


| Qt 


Spratling: Prognosis in Epilepsy. 


oftener to be due to certain causes in males, such 
as trauma, alcoholism, and syphilis, that the propor- 
tion of cures is somewhat higher among males than 
among females. 

But up to the beginning of adult life, I should say 
there is no difference. 

The Influence of the Mental Condition on Pre 
nosis.—The physician, habituated for years to the 
daily study of large numbers of epileptics of all 
types, comes sooner or later to experience certain 
intuitive feelings and conclusions as toa patient’s 
chances of recovery, through observation of the pa- 
tient’s mental condition alone. 

There are types of epilepsy that destroy all the 
faculties of the mind within a very short while. 
There are other types, of frequent expression, that 
leave the mind but little impaired, even if the epi- 
lepsy exists from infancy to the end of the ordinary 
span of life. Again, there are epileptics who seem 
to manifest almost no mentality; not because it has 
been lost, but because of its subversion through 
powerful bromide drugging that has gone on un- 
interruptedly for years. 

This was notably true in the case of the man who 
had 50,000 to 60,000 seizures before entering the 
colony, whose epilepsy had existed sixteen years, 
and who was accustomed to receive 120 or more 
grains of bromide daily, merely as a routine treat- 
ment. His mental condition on admission was most 
unsatisfactory, but it beeen to improve at once ee 
the bromide was stopped. 

Of late years the bromides have been far more 
rationally administered.. Epileptics are seldom ad- 


Pape 


bay pratling: Prognosis in Epilepsy. 


mitted to the colony at this time showing such dis- 
tressing evidences of bromide intoxication we were 
accustomed to see so often six to eight years ago. 

In a study of 1,364 cases we were struck with the 
undoubted relationship between the mental state, the 
age at the onset of the epilepsy, and the average 
duration of the disease. 

Two hundred and forty-one patients, whose men- 
tal condition was described as “ good,” had an aver- 
age age at the onset of their epilepsy of fourteen 
years, while the average duration of their disease 
was 9.8 years. 

We parallel these with 97 epileptic imbeciles, 
whose average age at the onset of their epilepsy was 
5-3 years, the average duration of their disease be- 
ing eleven years and a half. 

The rule, therefore, seems to be that the younger 
the patient when the epilepsy develops, the longer 
its duration without proper treatment, the more un- 
satisfactory the mental condition becomes. 

The prognosis in epilepsy is always better when 
the mind in its essential elements is unimpaired. 

Length of Tume the Cases in Question Have Been. 
Free from Attacks.—In this lies the very keystone 
of the arch of all that is valuable in the subject. I 
have previously given it as my belief that a person 
may be cured of epilepsy, and then have it again. 

Epilepsy is not essentially different from insanity 
in this respect, notwithstanding the longer time it 
takes to cure it, and its lower percentage of cures at 
the present time. 

Ten of the 34 cases I am reporting had gone, on 
January 1, 1904, five years or over, without an at- 


23 


Spratling: Prognosis in Epilepsy. 


tack (some of them, seven years and over) ; 7 had 
gone four years and over; 11, three years and over ; 
while 6 had gone two years and over. 

Some writers on epilepsy assume to fix a definite 
length of time an individual should remain free from 
attacks before he can be regarded as cured. 

Turner, an English epileptologist of note, sets the 
time of freedom from attacks as a prerequisite of 
cure, at nine years. I think this is too long. The 
patient is apt to lose hope, a thing in itself that 
greatly hazards his recovery. 

I do not see how any inflexible rule can be made 
to cover this point. The best we can do is to study 
the peculiarities of individual cases and fix a period 
in each case. 

Some epileptics can be cured in from two to three 
years, in a way permanently to remain so; others 
can be cured only with the greatest difficulty in three 
to five years, and only with the greatest difficulty 
kept so. 

It may be thought that the 34 recoveries I have 
here reported constitute a small percentage of the 
total number that have been under treatment at 
Sonyea. In explanation of this, I will say that one- 
half of the patients who have been admitted to the 
Craig Colony to this time have been regarded as 
wholly incurable at the time of their admission. 

One half or more suffered from epileptic demen- 
tia, idiocy, or imbecility ; their condition in all re- 
spects being so unsatisfactory as to render the 
possibility of cure out of question. After deduct- 
ing 50 per cent. as unmistakably incurable, we 
have about 665 more or less chronic cases left, and 


24 


Spratling: Prognosis in Epilepsy. 


it is from among these that the 34 recoveries have 
been effected. They constitute about 5 I-5 per 
cent. of the 665 possibly curable cases. 

If a colony like Sonyea could get one half its pa- 
tients before their epilepsy became chronic, and if 
it could have the almost unlimited resources found, 
or that should be found, in well equipped modern 
private sanitaria, including an ample corps of well 
paid physicians, each having from 20 to 30 patients 
only to treat in a day, instead of 125 to 150 or more, 
I am confident that the recoveries in epilepsy within 
a few years’ time could be raised fully as high as 
they now are among the insane—that is 25 per cent. 
to 30 per cent. or more. 

As a final word, I desire to reassert my unquali- 
fied belief in the curability of a disease there is too 
often failure to treat in the manner to attain the best 
results. Not only can it be cured, but not infre- 
quently cases that are apparently most hopeless can 
be improved in a way to make them useful factors in 
a community’s life. 


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